An Enhanced Recovery After Surgery (ERAS) program can significantly improve recovery for patients undergoing surgery for unruptured brain aneurysms by reducing pain, nausea and opioid use, according to a new study by researchers at Severance Hospital.
The research team, led by neurosurgeons Kim Yong-bae, Park Geun-young, Kim Jeong-jae, Han Hyun-jin, Kim Sol-bi and Oh Ji-woong, reported that applying an ERAS protocol improved postoperative recovery without increasing complications. The findings were published in the Journal of Neurosurgery.
ERAS is a standardized perioperative care program designed to accelerate recovery through measures such as preoperative education, optimized anesthesia and pain management, and early postoperative eating and mobilization.
As populations age and routine health screenings become more common, diagnoses of unruptured cerebral aneurysms have increased, leading to more surgical interventions. Despite advances in surgical techniques, conventional open aneurysm clipping is still associated with postoperative pain, nausea, vomiting and delayed recovery.
While ERAS programs have been widely adopted in general surgery and have been shown to shorten hospital stays and reduce complications, standardized protocols for neurosurgical procedures—particularly aneurysm clipping—have remained limited.
The researchers evaluated the effectiveness of an ERAS program in 414 patients who underwent clipping surgery for unruptured cerebral aneurysms at Severance Hospital, comparing 180 patients treated under the ERAS protocol with 234 patients who received conventional care.
The ERAS protocol included preoperative education and reduced fasting, local anesthesia for the scalp and head fixation sites, preventive anti-nausea medication during surgery, minimized opioid use, multimodal non-opioid pain management, and early postoperative walking and oral feeding.
Patients in the ERAS group experienced significantly better outcomes than those receiving conventional care. Postoperative pain scores fell by approximately 57%, opioid use declined by about 90%, and the incidence of postoperative nausea and vomiting dropped by roughly 80%.
Patients also recorded an approximately 9% improvement in Quality of Recovery-40 (QoR-40) scores, a widely used measure of overall postoperative recovery.
The study further found that participation in the ERAS program independently reduced the risk of postoperative pain and nausea without increasing surgical complications.
“Today, a successful operation is no longer defined solely by the absence of complications,” Kim said. “Reducing pain and enabling patients to return to daily life more quickly have become equally important measures of success. ERAS offers a new treatment paradigm by integrating care before, during and after surgery to improve the overall recovery experience.”